ABSTRACT
Resumo O "excepcionalismo" da infecção pelo HIV diz respeito ao fato de essa doença ser considerada tão diferente das demais e de que sua testagem necessita de uma abordagem especial em relação ao consentimento informado. Frequentemente, pessoas infectadas pelo HIV visitam unidades de assistência à saúde, sobretudo prontossocorros, anos antes de receberem um diagnóstico, sem terem sido testadas nessas oportunidades. Existe considerável interesse público em ampliar a testagem para o HIV em prontos-socorros. Por se tratar de ambiente sensível, cuja missão principal é o cuidado de urgências e emergências, há questionamentos quanto a esse ser um local apropriado para um programa de rastreamento universal, notadamente por questões éticas. Assim, os "direitos humanos dos pacientes" (DHP) constituem referencial teórico essencial para a análise de conflitos éticos que surgem no encontro clínico, fortalecendo a efetiva aplicação dos direitos humanos ao cuidado em saúde.
Abstract HIV exceptionalism refers to the fact that the illness is so different from other diseases that testing needs a special approach to informed consent. HIV infected people often visit health clinics, especially emergency departments, years before receiving a diagnosis without being tested for HIV. There is considerable public interest in increasing HIV testing in emergency departments. However, because these departments are sensitive environments that primarily provide urgent and emergency care, a number of ethical questions have been raised about the appropriateness of these settings for the implementation of universal screening programs. Human rights in patient care therefore constitutes an essential theoretical framework for analyzing ethical and legal dilemmas that arise in clinical encounters, thus strengthening the application of human rights principles to the context of patient care.
ABSTRACT
Objective@#To examine the correlation between atmospheric PM2.5 and emergency call for respiratory diseases.@*Methods@#The daily emergency call for respiratory and cardio-cerebrovascular diseases was collected from Hangzhou Emergency Medical Center from 2018 to 2020, and meteorological and atmospheric pollutant data were collected from Hangzhou Municipal Center for Ecological and Environmental Monitoring during the same period, including daily mean air temperature, daily mean relative humidity, PM2.5, PM10 and SO2 levels. The correlation between atmospheric PM2.5 and emergency call for respiratory and cardio-cerebrovascular diseases was examined using a generalized additive model, and the risk of emergency call was predicted using excessive risk (ER) and its 95%CI.@*Results@#The daily mean emergency call was 14 (interquartile range, 12) cases for respiratory diseases and 20 (interquartile range, 7) cases for cardio-cerebrovascular diseases in Hangzhou City from 2018 to 2020, and the daily mean PM2.5 mass concentration was 29.77 (interquartile range, 21.32) μg/m3. Cumulative exposure to PM2.5 for 5 or 6 d caused the largest effect on the emergency call for respiratory diseases, and an increase in PM2.5 by 10 μg/m3 led to a 1.93% (95%CI: 0.76%-3.11%) rise in the emergency call for respiratory diseases. Cumulative exposure to PM2.5 for 4 d caused the largest effect on the emergency call for cardio-cerebrovascular diseases, and an increase in PM2.5 by 10 μg/m3 led to a 1.88% (95%CI: 0.80%-2.97%) rise in the emergency call for cardio-cerebrovascular diseases. Cumulative exposure to PM2.5 for 7 d caused the largest effect on the emergency call for respiratory diseases among residents aged 60 years and older, and an increase in PM2.5 by 10 μg/m3 led to a 4.37% (95%CI: 2.70%-6.06%) rise in the emergency call for respiratory diseases. Cumulative exposure to PM2.5 for 4 d caused the largest effect on the emergency call for cardio-cerebrovascular diseases among residents aged 60 years and older, and an increase in PM2.5 by 10 μg/m3 led to a 2.44% (95%CI: 0.97%-3.52%) rise in the emergency call for cardio-cerebrovascular diseases. However, exposure to PM2.5 had no marked effects on emergency call for respiratory or cardio-cerebrovascular diseases among residents aged <60 years.@*Conclusions@#Elevated atmospheric PM2.5 mass concentration may lead to an increase in the daily emergency calls for respiratory and cardio-cerebrovascular diseases, notably among residents aged 60 years and older.
ABSTRACT
The growth of emergency services in Singapore over years in terms of volume and complexity is relentless. In the pre-hospital environment, ambulance call volumes have more than doubled from 62,095 in 1997 to 142,549 cases in 2012. The use of emergency ambulances services should be commensurate with the timeframe of which the medical condition is deteriorating or the potential for sudden catastrophic outcomes. Activation of the EAS ambulance for STEMIs and strokes help to reduce the D2B time and time to thrombolysis. Patients at risk of AMI or stroke often fail to recognise the symptoms and hence fail to activate the EMS system. Physicians do have a role to identify those at risk to educate them to achieve better outcomes. Good documentation of positive and significant negative findings and relevant tests provides a baseline to expedite patient assessment at the ED. An understanding of the available ED resources as well as the access to services, especially when subspecialty consultation is needed, helps to improve the appropriateness of referrals.
ABSTRACT
The growth of emergency services in Singapore over years in terms of volume and complexity is relentless. In the pre-hospital environment, ambulance call volumes have more than doubled from 62,095 in 1997 to 142,549 cases in 2012. The use of emergency ambulances services should be commensurate with the timeframe of which the medical condition is deteriorating or the potential for sudden catastrophic outcomes. Activation of the EAS ambulance for STEMIs and strokes help to reduce the D2B time and time to thrombolysis. Patients at risk of AMI or stroke often fail to recognise the symptoms and hence fail to activate the EMS system. Physicians do have a role to identify those at risk to educate them to achieve better outcomes. Good documentation of positive and significant negative findings and relevant tests provides a baseline to expedite patient assessment at the ED. An understanding of the available ED resources as well as the access to services, especially when subspecialty consultation is needed, helps to improve the appropriateness of referrals.